The proposed project will demonstrate and evaluate the relative effectiveness of three case management approaches in serving individuals with serious, disabling mental illness in one of the nation's most troubled urban areas. A professional "intensive case management" model will be compared with a collaborative model adding paraprofessionals to the team and a similar collaborative model in which recovering clients are used as "peer specialists". Funds will be used to develop the peer specialist and paraprofessional components and to pay for part of the evaluation. The project will be carried out in the borough of Bronx in New York City and the evaluation will be tied to a statewide study of a new Intensive Case Management program currently being implemented throughout New York State. The three models will be compared with respect to their effect on client outcomes, including successful engagement in services, community tenure, self-esteem, mastery, and quality of life. the experimental design includes random assignment of clients from a pre- determined "roster" of the most difficult to serve individuals in the area to the three case management conditions. In addition, an analysis will be conducted to determine differences in the actual interventions employed in the three models, and to examine the effects of paid peer- specialists on the individuals hired by the project.